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Atypical posterior reversible encephalopathy syndrome in a noncompliant hemodialysis patient: Case report and literature review.
Hemodial Int. 2019 10; 23(4):E100-E103.HI

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a reversible vasogenic brain edema in patients who present with seizure, headache, visual disturbance, and altered mental status, and a characteristic neuroimaging profile. Although PRES predominantly affects the bilateral parieto-occipital areas, involvement of the frontal and temporal lobes, basal ganglia, brainstem, and cerebellum is not uncommon. Isolated involvement of the brainstem and cerebellum sparing the parieto-occipital lobe is rarely reported. Here, we describe a 47-year-old man with end-stage renal disease on chronic hemodialysis who presented with prominent hypertension and coma after missing three dialysis sessions. On examination, there was paucity of focal neurologic signs. Diagnosis of PRES was based on brain magnetic resonance imaging findings that were consistent with vasogenic edema of the pons and cerebellum without involvement of other areas. With antihypertensive therapy and intense ultrafiltration during hemodialysis, the patient's blood pressure and consciousness returned to normal, along with complete resolution of the abnormal imaging findings. This case stresses that noncompliance with dialysis should be considered a risk factor for PRES. This case is considered relative to the available literature on three patients with brainstem variant of PRES.

Authors+Show Affiliations

Division of Nephrology, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan. Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Department of Radiology, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan. Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Department of Radiology, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan. Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.Division of Neurology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

30735291

Citation

Chiang, Wen-Fang, et al. "Atypical Posterior Reversible Encephalopathy Syndrome in a Noncompliant Hemodialysis Patient: Case Report and Literature Review." Hemodialysis International. International Symposium On Home Hemodialysis, vol. 23, no. 4, 2019, pp. E100-E103.
Chiang WF, Chen PT, Chen YL, et al. Atypical posterior reversible encephalopathy syndrome in a noncompliant hemodialysis patient: Case report and literature review. Hemodial Int. 2019;23(4):E100-E103.
Chiang, W. F., Chen, P. T., Chen, Y. L., & Chen, M. H. (2019). Atypical posterior reversible encephalopathy syndrome in a noncompliant hemodialysis patient: Case report and literature review. Hemodialysis International. International Symposium On Home Hemodialysis, 23(4), E100-E103. https://doi.org/10.1111/hdi.12735
Chiang WF, et al. Atypical Posterior Reversible Encephalopathy Syndrome in a Noncompliant Hemodialysis Patient: Case Report and Literature Review. Hemodial Int. 2019;23(4):E100-E103. PubMed PMID: 30735291.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atypical posterior reversible encephalopathy syndrome in a noncompliant hemodialysis patient: Case report and literature review. AU - Chiang,Wen-Fang, AU - Chen,Pei-Ti, AU - Chen,Yen-Lin, AU - Chen,Ming-Hua, Y1 - 2019/02/08/ PY - 2018/04/12/received PY - 2018/11/26/revised PY - 2019/2/9/pubmed PY - 2020/6/24/medline PY - 2019/2/9/entrez KW - Brainstem KW - dialysis KW - magnetic resonance image KW - posterior reversible encephalopathy syndrome SP - E100 EP - E103 JF - Hemodialysis international. International Symposium on Home Hemodialysis JO - Hemodial Int VL - 23 IS - 4 N2 - Posterior reversible encephalopathy syndrome (PRES) is a reversible vasogenic brain edema in patients who present with seizure, headache, visual disturbance, and altered mental status, and a characteristic neuroimaging profile. Although PRES predominantly affects the bilateral parieto-occipital areas, involvement of the frontal and temporal lobes, basal ganglia, brainstem, and cerebellum is not uncommon. Isolated involvement of the brainstem and cerebellum sparing the parieto-occipital lobe is rarely reported. Here, we describe a 47-year-old man with end-stage renal disease on chronic hemodialysis who presented with prominent hypertension and coma after missing three dialysis sessions. On examination, there was paucity of focal neurologic signs. Diagnosis of PRES was based on brain magnetic resonance imaging findings that were consistent with vasogenic edema of the pons and cerebellum without involvement of other areas. With antihypertensive therapy and intense ultrafiltration during hemodialysis, the patient's blood pressure and consciousness returned to normal, along with complete resolution of the abnormal imaging findings. This case stresses that noncompliance with dialysis should be considered a risk factor for PRES. This case is considered relative to the available literature on three patients with brainstem variant of PRES. SN - 1542-4758 UR - https://www.unboundmedicine.com/medline/citation/30735291/Atypical_posterior_reversible_encephalopathy_syndrome_in_a_noncompliant_hemodialysis_patient:_Case_report_and_literature_review_ L2 - https://doi.org/10.1111/hdi.12735 DB - PRIME DP - Unbound Medicine ER -